Diabetes Mellitus and Periodontal Disease : awareness and practice among doctors working in public General Out-Patient Clinics in Kowloon West Cluster of Hong Kong

Problem

Both DM and periodontal disease are common in Hong Kong. At least 10% Hong Kong population suffer from type 2 DM and 40% people have some degree of periodontal disease. Thus, many patients should have both diseases at the same time. It is known that DM and periodontal disease have bidirectional relationship with each other. However, not all primary care doctors are aware of this relationship and even if they are aware of the relationship, it may not affect their practice when managing patients.

Approach

Doctors’ awareness and practice regarding DM and periodontal disease was assessed by a cross-sectional questionnaire survey. There was no validated questionnaire on this aspect suitable for local use. Thus, a tailor-made questionnaire was developed for this study. All doctors in the Department of Family Medicine and Primary Health Care in Kowloon West Cluster, Hospital Authority, Hong Kong were invited for a cross-sectional questionnaire survey to determine their awareness of the relationship between diabetes mellitus (DM) and periodontal disease; and to survey their corresponding relevant practice on DM patients.

Findings

168 questionnaires were sent out, 143 were returned (response rate 85.1%). 140 valid questionnaires were analyzed. Ninety-two percent of participants were aware of a relationship between DM and periodontal disease and this awareness was not associated with their years of experience, training status and personal oral health behavior. Ninety percent knew the effect of poor DM control on periodontal disease but only 76% were aware of the reverse effect of periodontal disease on DM. The difference was statistically significant (p=0.002, Related-samples Sign Test). In clinical practice on DM patients, only 5.7% asked dental history often (defined as 50% patients or above), 7.1% examined their mouths often and 12.1% recommended them to see dentist often. Logistic regression showed that awareness factors had no association with periodontology related clinical practice whereas clinical experience, being a Family Medicine specialist and personal interdental cleaning habit were associated with some positive effect on the practice.

Consequences

A high proportion of doctors in the study were aware of the relationship between DM and periodontal disease. However, this did not appear to influence their practice. Further measures among doctors and patients to promote comprehensive management of DM and periodontal disease should be explored.